【摘要】：研究背景:冠狀動(dòng)脈粥樣硬化性心臟病(冠心病coronary heart disease,CHD)已經(jīng)成為威脅人類健康的主要疾病之一。目前大量研究表明血脂異常,尤其總膽固醇(total cholesterol,TC)和低密度脂蛋白膽固醇(low density lipoprotein-cholesterol LDL-C)升高是CHD最主要的危險(xiǎn)因素之一,強(qiáng)化調(diào)脂治療可以使CHD患者明顯獲益。目前調(diào)脂藥物的主要作用機(jī)制是抑制膽固醇的合成或吸收。而膽固醇代謝去路異常同樣可以使TC和LDL-C升高,膽固醇在體內(nèi)的主要代謝去路是通過(guò)轉(zhuǎn)化為膽汁酸隨膽汁排出體外,國(guó)內(nèi)有研究提示血清總膽汁酸(total bile acid,TBA)水平與CHD相關(guān),但TBA水平與冠狀動(dòng)脈病變程度有無(wú)相關(guān)性尚少有研究,如果有證據(jù)表明TBA水平與冠狀動(dòng)脈病變程度相關(guān),臨床將多一項(xiàng)預(yù)測(cè)冠脈病變程度的指標(biāo),同時(shí)為CHD的防治提供新思路。目的:探討CHD患者TBA水平與冠狀動(dòng)脈病變嚴(yán)重程度的相關(guān)性,進(jìn)一步探尋評(píng)估冠狀動(dòng)脈病變嚴(yán)重程度的臨床指標(biāo),為防治冠狀動(dòng)脈病變提供新的思路。方法:選取經(jīng)冠狀動(dòng)脈造影(coronary angiography,CAG)檢查確診的CHD患者120例為冠心病組;選取經(jīng)CAG檢查除外冠心病的患者60例為對(duì)照組。收集兩組患者血清TBA水平及冠心病組CAG結(jié)果。采用Gensini評(píng)分系統(tǒng)對(duì)CHD患者CAG結(jié)果進(jìn)行評(píng)分。兩組間血清TBA水平比較采用獨(dú)立樣本t檢驗(yàn),采用Pearson相關(guān)分析檢測(cè)CHD患者血清TBA水平與Gensini評(píng)分的相關(guān)性。采用logistic回歸分析CHD的多重危險(xiǎn)因素。結(jié)果:冠心病組血清TBA水平明顯高于對(duì)照組(4.92±2.22)VS(3.01±1.89)umol/L,P0.05;Pearson相關(guān)分析顯示冠心病患者血清TBA水平和Gensini評(píng)分有明顯相關(guān)性(r=0.67,P0.05)。進(jìn)一步以TBA4.0umol/L和TBA≥4.0umol/L為二分變量,應(yīng)用二分類logistic回歸分析調(diào)整了心血管危險(xiǎn)因素后,結(jié)果顯示TBA≥4.0umol/L是CHD的獨(dú)立危險(xiǎn)因素(OR:2.31,95%CI:1.13~4.69,P0.05)。結(jié)論:冠心病患者血清TBA水平與冠狀動(dòng)脈病變嚴(yán)重程度密切相關(guān),TBA水平升高可能是CHD的危險(xiǎn)因素,TBA水平可作為預(yù)測(cè)冠狀動(dòng)脈病變嚴(yán)重程度的指標(biāo),干預(yù)膽汁酸代謝有可能成為預(yù)防和治療CHD的新途徑。
[Abstract]:Background: coronary atherosclerotic heart disease (coronary heart disease,CHD) has become one of the major diseases threatening human health. At present, a large number of studies have shown that dyslipidemia, especially the increase of total cholesterol (total cholesterol,TC) and low density lipoprotein cholesterol (low density lipoprotein-cholesterol LDL-C), is one of the most important risk factors for CHD. Intensive lipid regulation therapy can significantly benefit CHD patients. At present, the main mechanism of lipid-regulating drugs is to inhibit the synthesis or absorption of cholesterol. The abnormal metabolic pathway of cholesterol can also increase TC and LDL-C. The main metabolic pathway of cholesterol in vivo is by transforming bile acid out of the body. Domestic studies have suggested that the level of serum total bile acid (total bile acid,TBA is related to CHD. However, there are few studies on the correlation between TBA level and coronary artery lesion degree. If there is evidence that TBA level is related to coronary artery lesion degree, there will be a new index to predict coronary artery lesion degree in clinic, and a new idea for the prevention and treatment of CHD will be provided at the same time. Objective: to explore the correlation between the level of TBA and the severity of coronary artery disease in patients with CHD, and to explore the clinical indexes to evaluate the severity of coronary artery disease, so as to provide a new idea for the prevention and treatment of coronary artery disease. Methods: 120 patients with CHD diagnosed by coronary angiography (coronary angiography,CAG) were selected as coronary heart disease group, and 60 patients who were excluded from coronary heart disease by CAG were selected as control group. The level of serum TBA and the results of CAG in coronary heart disease group were collected. The CAG results of CHD patients were evaluated by Gensini scoring system. Serum TBA levels were compared by independent sample t-test and Pearson correlation analysis was used to detect the correlation between serum TBA level and Gensini score in patients with CHD. Multiple risk factors of CHD were analyzed by logistic regression analysis. Results: the serum TBA level in coronary heart disease group was significantly higher than that in control group (4.92 鹵2.22) VS (3.01 鹵1.89) umol/L,P0.05;Pearson correlation analysis showed that there was a significant correlation between serum TBA level and Gensini score in patients with coronary heart disease (P 0.05). Furthermore, with TBA4.0umol/L and TBA 鈮，

本文編號(hào)：2201903